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Most domestic and family violence (DFV) research has focused on establishing prevalence and screening rates in public health and community samples. This study sought to address a gap in the literature by evaluating DFV screening and response practices in a private mental healthcare inpatient service and determining if clients of the service had unmet DFV needs. A prospective, convenience sample, mixed methods, cross-sectional survey of adult inpatient mental health consumers was employed. Sixty-two participants completed the Royal Melbourne Hospital Patient Family Violence Survey. Quantitative Likert-type and categorical responses were collated and analysed descriptively (count and percentage). Free-text responses were analysed using qualitative description within a content analysis framework. Sixty-five percent of participants had been screened for at least one DFV issue, on at least one occasion, with 35% not being screened, to their recall. Twenty-three percent reported disclosing DFV concerns, 82% felt very supported by the clinician's response to their disclosure, and 86% were provided with information they found helpful. Unmet needs were identified in 13% of participants, who had wanted to disclose DFV concerns but not feel comfortable to do so. No unscreened respondents disclosed DFV concerns, highlighting the need to uphold best practice guidelines for direct enquiry. Most disclosing clients were positive about the support they received. Indicated areas for improvement were screening rates, active follow-up, increasing psychology support levels and safety planning., (© 2024 The Author(s). International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Background: Rates of family violence are high in many societies, with disproportionate impacts on women and children. Healthcare services have an important gateway role for victim-survivors requiring assistance. There is limited evidence regarding how much training is required for hospital clinicians to be adequately prepared to work effectively with clients experiencing family violence., Objectives: This study aimed to investigate the impact of different levels of training in family violence, on the knowledge and confidence of hospital clinicians., Design: A cross-sectional, online, survey of hospital clinicians in a major trauma hospital was conducted. The study evaluated the impact of level of family violence training (no training, some training, clinical champions) on staff self-reported family violence knowledge and confidence levels., Methods: The Assisting Patient/Clients Experiencing Family Violence: Royal Melbourne Hospital Clinician Survey tool was utilised, and open for clinicians to complete, anonymously over a 6-week period., Results: In total, 526 clinical staff participated across a range of profession groups (Allied Health, 47%; Nursing 40%; Medical 13%). Staff with some training (mean training hours 3.25, SD 5.23) rated their knowledge and confidence levels at least two-thirds higher than those with no training. Those trained as clinical champions (mean training hours 14.60, SD 9.14) rated their knowledge and confidence at least 50% higher than staff with some training. An even more pronounced elevation across training levels was seen with specific family violence clinical skills - identifying the signs of family violence, knowing how to screen patients and providing an appropriate response to disclosures., Conclusions: Training in family violence clinical response significantly increased self-reported knowledge and confidence levels of hospital staff, with the extra time and resourcing required to train clinical champions, showing clear benefits. The provision of evidence-based and well-resourced family violence education for healthcare professionals is required to drive clinical practice improvements for victim-survivors.

Background: As frontline healthcare workers, there is a growing expectation that nurses should be able to respond to disclosures of family violence. However, the profession and hospital systems have been slow to respond with clear skills, knowledge and confidence deficits identified in existing research. There is limited research which has robustly evaluated the effectiveness of in-depth, multifaceted training on readiness to respond among nurses., Aim: To longitudinally evaluate the effectiveness of an in-depth family violence training intervention on confidence, knowledge and clinical skills of nurses working in a large tertiary adult hospital., Design: Single-centre, longitudinal intervention study. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used., Methods: One hundred and ten nursing clinicians participated in this study to complete a comprehensive evidence-based model of healthcare workers response for assisting patients experiencing family violence. A mixed methods survey was used to assess change in knowledge, confidence and clinical skills among participants. Outcome assessment was electronically undertaken at baseline, 6-9 months and 12-15 months following intervention., Results: Statistically significant improvement was seen in self-reported knowledge, confidence and frequency of screening for family violence. Relative to baseline estimates, these improvements were identified 6-9 months and 12-15 months following intervention; albeit with consideration to the visually observed trend of skill reversion at follow-up. Quantitative findings were paralleled by qualitatively identified improvements in the recognition of the intersectional nature of violence, need for patient collaboration in screening and depth in considerations around how family violence is screened for., Conclusions: Findings provide tentative support for the utility of a multidimensional training approach to improving nurses' readiness to respond to disclosures of family violence., Relevance to Clinical Practice: This study provides preliminary support for multidimensional, evidence-based training to effectively improve nurses' confidence, knowledge and clinical skills required for responding to family violence., Reporting Method: The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (SQUIRE) Statement: guidelines for reporting observational studies (see Table S1)., Patient Contribution: Patients were involved in the initial design of the survey tool. This involvement came through the Allied Health Consumer panel and included input on the design and question wording of the survey items., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Objective This case study describes the development and outcomes of a new integrated and multidisciplinary care pathway. Spearheaded by allied health, the 'COVID community navigator team', applied established principles of reverse triage to create additional surge capacity. Methods A retrospective cohort study examined workflow patterns using electronic medical records of patients who received navigator input at the Royal Melbourne Hospital between 20 September 2021 and 20 December 2021. Results There were 437 eligible patient encounters identified. On average patients stayed 4.15 h in the emergency departments (ED) (s.d. = 4.31) and 9.5 h (s.d. = 10.9) in the short stay unit. Most patients were discharged into a 'low risk pathway' with community general practitioner follow up. Of discharged patients, only 38 re-presented to the ED with symptoms related to their initial COVID-19 diagnosis (34.9% of total re-admissions). Of these re-admissions, more than half did not require admission to a ward. Conclusion The findings presented here provide support for the clinical utility of a multidisciplinary reverse triage approach in surge planning for anticipated presentation peaks.

Family violence is a significant public health issue. Healthcare systems have an important role to play in recognising and responding to current family violence experiences in their patients. However, many healthcare workers and systems remain underprepared to fulfil this role. The current study evaluated the impact of a transformational change project in family violence clinical response at a major adult trauma hospital in Australia. Clinician self-rated knowledge, confidence, and family violence clinical skills were evaluated at three years post implementation of a family violence initiative at the Royal Melbourne Hospital, Melbourne. The three years post survey results ( N  = 526) were compared to baseline ( N  = 534) using Mann Whitney U and χ 2 analyses. Self-reported clinician family violence knowledge, confidence and patient screening were all significantly improved from baseline. Specific family violence skills, including knowledge of key indicators, enquiry with patients and disclosure response were also all significantly improved. The most common clinician identified barriers to working effectively in the area were similar to baseline and included the presence of a suspected perpetrator during the clinical interaction, clinicians perceiving patients would be reluctant to disclose, and time limitations. However, significantly fewer staff endorsed a lack of knowledge or supporting policies and procedures as a barrier. The findings indicate that investment in a transformational change project comprised of the establishment of response policies and clinical work-flow, broad-scale training, a clinical champions program, a secondary consultation service and links with partner organisations, was effective at improving clinician self-rated rated family violence skills, across the hospital. However, one quarter of clinicians still reported having not received any family violence training, and half endorsed having little or no confidence in their skills to identify and respond to patient family violence experiences. This indicates ongoing and sustained work is required to optimise clinician skills in responding to family violence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Fisher, Troy, Rushan, Felmingham and Withiel.)

Objectives: General practitioners face many barriers to deprescribing psychotropic medications in people with dementia in nursing homes, including a lack of knowledge about their medication histories. This study explored the knowledge of family members about residents' medications and their willingness to support deprescribing., Methods: Sixty-six family members of residents from seven residential aged care facilities participated in this cross-sectional study. Participation involved nomination of recognised medications, rating their effectiveness and rating level of support for deprescribing., Results: Fifty-five per cent of medications were recognised by family members; significantly fewer psychotropics were recognised than non-psychotropic medications. Though rated as just as effective, support for deprescribing psychotropics was significantly higher. Most family members were agreeable to deprescribing with general practitioner support., Conclusions: Although there is a gap in family members' knowledge about psychotropic medications, overall they are supportive of deprescribing. Findings emphasise the need for psychoeducation among family members. Providing family members with a list of prescribed medications, specifying the type of and reason for prescription and side effects of each, is recommended to facilitate their advocacy for deprescribing on behalf of nursing home residents., (© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Introduction: Family violence (FV) is one of the most urgent health issues of our generation. While nurses play a vital role in identifying and supporting victim/survivors of violence, little is known about nursing readiness to respond across clinical areas., Objective: This study aimed to compare and contrast the knowledge, confidence, clinical skills, and perceived barriers of nurses across three clinical areas of a tertiary trauma hospital in Melbourne, Australia, in responding to FV., Method: A prospective, mixed methods design was used. The nursing staff at a large trauma hospital were approached to participate. Participants completed a brief online survey to quantify clinician-reported knowledge, clinical skills, and barriers to managing FV., Results: Two hundred and forty-two nursing staff electronically completed a brief survey to capture self-reported confidence, knowledge, clinical skills, and barriers to working effectively in the area. The descriptive analysis reflected service-wide deficits in knowledge, confidence, and self-reported clinical skills, irrespective of the work area. Deficits were identified on a background of limited structured training for FV among this cohort. Significantly higher rates of FV confidence and knowledge were identified among emergency department nurses relative to acute and subacute clinical counterparts., Conclusion: Nurse respondents overall reported low rates of confidence, knowledge, and clinical skills in responding to disclosures of FV. Findings reinforce the need for imbedded training programs to support frontline responses., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Mental healthcare services have an important role to play in recognizing and responding to domestic and family violence (DFV). This study aimed to evaluate staff knowledge, confidence, and clinical skills in family violence in an Australian private mental healthcare service. The methodology utilized was a cross-sectional, online survey of clinical staff. In total, 93 clinical staff participated (51 nursing, 37 allied health, and 5 medical), with a 29% response rate. Most clinicians reported working with patients who had disclosed experiencing family violence, but the majority of clinicians (63%) had received no training in the area, with nurses reporting the lowest training levels. Less than 20% reported definitive knowledge of important clinical skills including key family violence indicators, asking about family violence, and responding to disclosures. However, qualitative text response data indicated that many clinicians would provide responses that encompassed best-practice recommendations. Overall, the results indicated suboptimal clinician family violence knowledge, with further training needed, particularly in nursing staff. Stronger knowledge and skills in social workers and psychologists, relative to nurses, paralleled existing research in a medical hospital sample. The data from the study will be utilized to inform the implementation of a hospital-wide quality and service improvement project in the area of DFV clinical response., (© 2022 John Wiley & Sons Australia, Ltd.)

Introduction: Healthcare workers play a vital role in assessing and appropriately responding to family violence. Discipline-specific differences in the readiness to respond have been indicated in the literature but no studies have directly compared multiple disciplines using the same measure. Given the imperative need for a hospital-wide, multidisciplinary approach to managing family violence, this study aimed to compare and contrast clinician perceived levels of knowledge, confidence and clinical readiness to manage disclosures of family violence across major professional groups in a tier 1, tertiary adult trauma hospital in Australia., Methods: This prospective cross-sectional study implemented a brief questionnaire to explore self-reported knowledge, confidence and clinical skills in managing family violence. Data were analysed using non-parametric analyses. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for observational research were followed in the reporting of this study., Results: Significantly greater self-reported clinical skills, knowledge and confidence were found among social work clinicians relative to all other disciplines. By contrast, allied health clinicians reported the lowest levels of clinical knowledge, confidence and skills relative to other discipline areas. No significant differences were seen between nursing and medicine., Conclusion: There are significant differences across clinical professional groupings in knowledge and confidence levels, and clinical skills in assisting patients experiencing family violence. The findings have implications for facilitating a hospital-wide, multidisciplinary response to assisting clients experiencing family violence., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Aims and Objectives: To determine the baseline levels of training, knowledge and confidence working in the area of family violence in staff at a public child and maternal health service in Melbourne, Australia, as well as perceived staff barriers to working effectively in this area. This study also aimed to explore the client perception of existing screening practices., Background: Family violence is a global concern with pregnancy and the postnatal period times of particularly high risk. Child and maternal health services are well placed to screen for violence, yet clinician and client perceptions of screening remain poorly characterised., Design: Thirty-five staff and 15 mothers participated in this cross-sectional, mixed-method study, via an online survey. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used., Results: The majority of staff screened clients for family violence, at least some of the time, with over 50% often or always screening. However, only half of staff respondents indicated that they believed they knew how to screen appropriately. Screening occurred most often over the phone or at the first service visit. The most commonly reported barriers to screening were suspected perpetrators being present during consultations and language barriers. Most clients reported being screened for physical violence and safety in the home with few being asking about financial and sexual abuse, or psychological violence and coercive control. Clients who disclosed violence reported being well supported., Conclusion: While some baseline staff knowledge and skills have been identified, further support for clinicians is needed to ensure best practice and improve services and outcomes, particularly in regard to screening for different types of violence across the spectrum., Relevance to Clinical Practice: This study helps to inform clinical screening practices in maternal health services through an exploration of facilitators and barriers in the screening process., (© 2020 John Wiley & Sons Ltd.)

Purpose: Deficits in memory are common following stroke and have been independently linked with poorer outcomes. Outcomes and best-practice processes of post-stroke memory rehabilitation remain equivocal. Materials and method: In this study an AB with follow up single-case design was repeated across four participants to explore the effectiveness of a compensatory memory skills group in patients with stroke. Target behaviour was subjective everyday and prospective memory failures, assessed weekly. Secondary outcomes included goal attainment and performance on neuropsychological tests of memory. Following three-week baseline, participants completed six weekly two-hour sessions of a manualised memory group. Data was analysed visually and statistically. Results and conclusion: Frequency of everyday memory complaints reduced for all participants during the six-week post-intervention period. This change was significant for three participants. One of the four participants reported a significant reduction in the frequency of prospective memory failures during the maintenance period. All participants described attaining at least one memory specific goal following intervention. Group participation did not result in meaningful change on neuropsychological measures of memory. Taken together, results provided preliminary support for the effectiveness of group-based compensatory memory rehabilitation for reducing subjective everyday memory failures and functional goal attainment.IMPLICATIONS FOR REHABILITATIONMemory skills group training can improve subjective everyday memory and functional goal attainment in community dwelling survivors of stroke.Participants who are closer to date of injury may show greater changes in self-awareness as a consequence of group participation than those who are further from injury.Exploration of change following memory rehabilitation on standard neuropsychological tests may not be the best way to capture improvement following memory skills group training. A focus on functional memory outcomes is recommended to facilitate translation to person-centred clinical practice.

Computerised cognitive training (CCT) approaches to memory rehabilitation represent an attractive alternative to traditional approaches; however, there is limited empirical evidence to support their use. An AB with follow up single case design was repeated across five participants to explore the feasibility and effectiveness of CCT on subjective memory in patients with stroke. Target behaviour was subjective everyday and prospective memory failures which were assessed weekly. Following baseline (three weeks), participants completed six weeks of Lumosity TM training in their homes. Data were analysed visually and statistically. The frequency of prospective memory failures decreased during intervention for one participant, while the frequency of prospective and everyday memory failures decreased significantly during the follow up period for another participant. Yet, significantly more everyday and prospective memory failures were reported following training by one study participant. No significant change in subjective memory ratings was found for remaining participants. Regarding secondary outcomes, meaningful changes on objective measures of memory were not observed, despite considerable inter-individual variability. Three participants reported improvement in individualised memory goals, while two participants described a decline. Overall, Lumosity TM training appears feasible; however, no consistent evidence to support effectiveness of this CCT on subjective or objective memory was found.

Objective: Memory problems are commonly reported following stroke; however, the specific nature and frequency of memory complaints experienced by stroke survivors has not been sufficiently investigated. We aimed to investigate the factor structure of the Everyday Memory Questionnaire-Revised (EMQ-R) in stroke survivors with memory complaints, and identify the most commonly endorsed items. Method: A total of 91 stroke survivors completed the EMQ-R prior to participation in a memory rehabilitation trial. A principal components analysis was carried out on the EMQ-R data and reliability analyses were conducted on the resulting subscales. We described the average frequency of occurrence of specific memory complaints in one month, as reported by stroke survivors. Results: The factor analysis yielded a two-component solution which accounted for 60.12% of the variance, suggesting that two subscales termed Forgetting and Attention would be most appropriate for clinical use with stroke survivors. These subscales demonstrated strong internal reliability. A total of 87.9% of the participants reported having word-finding difficulties more than once monthly. Of all EMQ-R items, participants rated word-finding problems as occurring at the highest frequency (once or more daily). Conclusions: Stroke survivors' everyday memory complaints fall into two distinct categories relating to memory and attentional processes. Calculating scores on the two EMQ-R subscales separately may assist clinicians to understand the nature of memory complaints reported by stroke survivors who participate in memory rehabilitation programs, and may enable more targeted outcome measurement in research trials.

Memory impairment is common following stroke. Memory skills groups (MSGs) utilising compensatory strategies and computerised cognitive training (CCT) are two rehabilitation approaches available to improve memory function; however, there is no consensus as to which is more effective following stroke. This study aimed to explore and contrast the qualitative experiences of 20 stroke survivors ( M age  = 61.90, SD  = 10.48, range: 34-77 years) who received six weeks' training in MSG (manualised memory skills group, n  = 10) or individual-CCT ( Lumosity TM , n  = 10). Using semi-structured interviews, data were collected and analysed thematically, adopting a critical realist approach. Six themes were identified: (1) Facilitators and barriers to intervention engagement , (2) Improving knowledge and understanding , (3) Connecting with others , (4) Perception of the intervention , (5) Impact on everyday memory and (6) Impact on emotions and sense of purpose . Encouragingly, most participants valued and enjoyed participating in the memory interventions, irrespective of rehabilitation approach. MSG participants reported learning and sharing with similar others as important to the experience and described everyday memory improvements. CCT participants described enjoyment of its game-like nature, yet reported frustration associated with game-specific characteristics, and did not report everyday memory improvements.

Objectives: Family violence is a public health issue. It occurs in many forms, is most commonly directed at woman and children, and contributes significantly to death, disability, and illness. This study was conducted in the clinical staff in a large metropolitan hospital and aimed to determine levels of family violence training, self-perceived knowledge and confidence, specific clinical skills, and barriers to working effectively in the area., Methods: A short, targeted online survey was designed to capture the required information. Descriptive statistics were calculated, and free-text responses were analyzed using qualitative content analysis., Results: Survey responses were received from 534 staff (242 nurses, 225 allied health, 67 medical). Sixty-five percent had received some form of family violence training, mostly of short duration (1-3 h); 72% reported having little or no confidence working in the area, while 76% indicated that they had little or no knowledge in the area. Longer duration training was associated with an increase in knowledge and confidence ratings. Family violence screening rates and knowledge of several specific family violence clinical skills (how to appropriately ask clients about family violence and family violence risk factors) were also low. Thirty-four percent indicated that they did not know what to do, when a patient disclosed experiencing family violence. The most commonly indicated barriers to working effectively in this area were suspected perpetrators being present, perceived reluctance of patients/clients to disclose when asked, and time limitations., Conclusion: This research provides a useful snapshot of clinical staff perceptions of their family violence skill levels in a large metropolitan Australian tertiary hospital. It highlights the need for further in-depth training in clinical health professionals in family violence. The research will allow for family violence training to be tailored to the needs of the professional discipline and clinical area.

Objectives: Memory deficits are common after stroke, yet remain a high unmet need within the community. The aim of this phase II randomized controlled trial was to determine whether group compensatory or computerized cognitive training approaches were effective in rehabilitating memory following stroke., Methods: A parallel, 3-group, single-blind, randomized controlled trial was used to compare the effectiveness of a compensatory memory skills group with restorative computerized training on functional goal attainment. Secondary outcomes explored change in neuropsychological measures of memory, subjective ratings of prospective and everyday memory failures and ratings of internal and external strategy use., Results: A total of 65 community dwelling survivors of stroke were randomized (24: memory group, 22: computerized cognitive training, and 19: wait-list control). Participants allocated to the memory group reported significantly greater attainment of memory goals and internal strategy use at 6-week follow-up relative to participants in computerized training and wait-list control conditions. However, groups did not differ significantly on any subjective or objective secondary outcomes., Conclusion: Preliminary evidence shows that memory skills groups, but not computerized training, may facilitate achievement of functional memory goals for community dwelling survivors of stroke. These findings require further replication, given the modest sample size, subjective nature of the outcomes and the absence of objective eligibility for inclusion.